The blog contains articles by the author which appear in various newspapers in Kashmir and are also available on the website: www.kashmirfirst.com

Wednesday, January 17, 2018

Kashmir’s Mismanaged Healthcare!

(Even though we have some of
the best doctors and reasonably good infrastructure, yet the general healthcare
remains below reasonably good standards due to administrative mismanagement!)

Recently on the
basis of an unverified sting operation conducted by a “notorious” TV channel
which has been depicting Kashmiris as anti-national criminals and rogues, the
government removed the head of the premier health institution of Kashmir and
some other consultants. Allegedly, some other motives than improvement in the
healthcare are attributed to this unprecedentedly fast step. The State
Government even disregarded the directions of the Honourable High Court in this
regard. One would not like to comment on the veracity of the episode before the
findings of any inquiry gives its report on the subject. Even if all the
allegations levelled are presumed to be true, the episode only represents the
proverbial tip of an iceberg as regards the state of healthcare in Kashmir
which suffers from acute mismanagement and neglect. If the rulers think they
can improve the working of the institution by merely changing its head, they
are mistaken. What is lacking in all such institutions is the absence of a
hospital administrator. Hospital Administration is a specialized subject and every
consultant, howsoever, excellent he may be in his specialized line, cannot
administer a specialized institution. Incidentally, the first head of the
institution was a real specialist in Hospital Administration. An instance of
mal-administration is running the Institute like an office. During night no
consultants or specialists are available. In fact, there is urgent need for
consultants to be on call and even some can stay within the premises for which
accommodation and food can be provided by the hospital. Similarly, casualty is
the face of a hospital. Again it looks like a fish market being attended by
junior doctors. It needs to have senior doctors from each specialty.

No one doubts
the capability and professional experience of Kashmiri doctors all over the
world. In fact some of the doctors have made a name in different fields of
medicine and surgery. One of the most renowned gastroenterologists is known all
over the world for his discovery of a certain type of hepatitis. One of the top
most cardiologists known all over the world is a Kashmiri. There are numerous
other doctors in various fields of medicine and surgery who are held in high
esteem in different foreign countries. In Kashmir itself we have had many
capable doctors. Dr. Ali Mohammad Jan had become a legend during his life time and
was probably the best physician in this part of the world. Even at present
there are so many doctors whose reputation goes much beyond the borders of the
state.

As regards
infrastructure, well, we can safely say that we are not lacking as compared to
other states or even to the top level facilities available in Delhi and other
metros. However, the main problem is mismanagement of the infrastructure and
the personnel involved in healthcare. Firstly, the premier institutions and
some of the major hospitals in Srinagar are forced to handle the entire load of
the Valley. This is because of lack of good primary health care throughout the
valley. If the primary health care in rural areas and districts is up to the
mark, there will be very much less load on Srinagar hospitals. Incidentally,
Government has made it mandatory for freshers to serve in rural areas. In fact,
it seems like a punishment! The need is for freshers to work with senior
doctors for at least 3 to 5 years to gain experience. Senior doctors with
experience should give some time in district hospitals and rural areas. They
can filter many cases leaving lesser load on major hospitals. An
endocrinologist and a neurologist in peripheral hospitals would be a great
help. Only specialized cases need to be referred here. At present every one
even with minor problems lands in Srinagar. The super specialty Institute has
virtually turned into a General Hospital. The outpatient departments there are
virtually like a Fish Market! One of the
reasons for that is lack of sufficient counters to get a ticket. Normally,
these counters should have been outside the hospital and the number of counters
could be increased for each specialty. Moreover, there could be two shifts of
outpatient care. The doctors in wards and the OPD could rotate during the day.

There are
district and sub-district hospitals in all parts of the valley. Some of these
may be quite well equipped but these are supposed to suffer because of the
absence of specialists and consultants. Similarly, some of the primary health
centres have always the problem of doctors not staying there. The absence of
specialists from district hospitals is attributed to these being non-teaching
hospitals and the service given there by consultants does not count towards
their teaching experience needed for promotion in various faculties. This
drawback prevents top consultants from going there for a posting. The primary
health centres have the problem of accommodation and other facilities for the
doctors and other staff posted there. Incidentally, some of the Kashmiri
doctors working in Middle Eastern countries have no objection in going to far
off places in the desert because the facilities provided there are even better
than those in the cities! Both these aspects need to be given top most
attention.

Incidentally,
there is only one Maternity and one Pediatric hospital in the entire valley to
cater for a population of 8 million people. Also Kashmir must be among the very
few places in the world where in Maternity and Pediatric hospitals two to three
patients are put on a single bed! No doubt the district hospitals take care of
various cases and refer only cases needing special treatment to Srinagar
institutions. However, people on their own rush to Srinagar hospitals because
of well-known consultants. The one possible solution could be to have some
smaller Maternity and Pediatric hospitals in various district headquarters. In
recent years a number of private “Hospitals” have come up in different parts of
Srinagar and some other places. Unfortunately, no one is bothered that these
units cannot be called hospitals in the real sense of the word. A hospital
should first of all have an emergency and a lifesaving facility such as a fully
equipped intensive care unit with ventilators and so on. Most of the private
hospitals here are upgraded polyclinics or nursing homes! No one seems to be
bothered about this aspect.

While talking of
so called malpractices which now include the banned so called private practice
by government doctors is only a tip of the iceberg. Firstly, there need not be
a ban on the private practice by Government employed doctors if this is done in
their own private time. They need not be given any non-practicing allowance but
can practice before or after their duty hours. However, on rotation some
doctors could remain available even after working hours which should be from 8
am to 6 pm. One cannot go by labour laws as regards healthcare. This is essential
to cater for patients all of whom cannot be attended during duty hours.
Everybody knows there is a great dearth of doctors especially the specialists.

Apart from
private practice, there are many other malpractices. There is supposed to be a
nexus between the pharmaceutical companies and doctors on one hand and between
diagnostic centres and the doctors on the other. Pharmaceutical companies give
many perks to doctors for prescribing particular brands. Apart from household
items, they are even offered foreign trips! Most of the diagnostic centres have
a liaison with some doctors who ask patients to get their investigations done
at some particular centres who reimburse them part of the charges levied on
patients for various tests. Sometimes poor patients are asked to go for a
number of tests which may not be essential for establishing a diagnosis!

Incidentally,
Kashmir is probably the largest consumer of drugs in the whole country. The
number of pharmacies is countless. One finds a pharmacy at every nook and
corner. Strangely, pharmacists can dispense any drug even without a
prescription. Antibiotics and many other scheduled drugs are sold over the
counter like sweets from a grocery! Apart from selling all types of drugs just
over the counter some of the pharmacists especially in remote areas have been
observed writing even prescriptions!

If one goes on
enlisting the ills of the healthcare, one may have to write many columns. Thus
the recent episode at SKIMS is only the tip of the iceberg. If the government
is sincerely and honestly interested in improving the healthcare both at the
basic as well as at the specialist level, an overhaul of the entire system is
required. The sooner it is done, better it would be for the good health of all!